By CHLOE WASKEY
The Ramspondents
In an incredibly rare divergence, the U.S. Food and Drug Administration issued vaccine recommendations this year that differed from those of the Centers for Disease Control and Prevention, highlighting the national partisan debate over vaccines and leaving Fort Collins residents confused in a tangle of federal policy changes, supply limits and pharmacy-level inconsistencies.
Although federal regulatory agencies have so far primarily targeted access to the Covid-19 vaccine, national vaccination rates have declined across the board since the beginning of President Donald Trump’s administration. In Colorado, measles cases have surged, 25% of pre-K students missed recommended immunizations and just this month a whooping cough outbreak emerged in Fort Collins.
As preventable diseases rise across the county, the FDA and CDC have seen key officials resign or be removed under U.S. Secretary of Health and Human Services Robert F. Kennedy Jr., disrupting long-standing processes for reviewing and coordinating vaccine policy. In the midst of that disarray, the FDA authorized Covid-19 vaccines only for adults over 64, infants and individuals labeled “high risk” under criteria that were never publicly clarified.
“We've seen that they have not used an evidence-based model,” said Nick Batty, the senior public health nurse for the Larimer County Department of Health and Environment. “They have not used a transparent model, and so what that means is there's now no confidence in their recommendations.”
The CDC then broke precedent by issuing a different recommendation, advising that people aged six months to 64 receive the vaccine only through “shared clinical decision-making,” a murky middle ground that requires documented proof of a discussion between doctor and patient resulting in consent to immunization. That mismatch between federal agencies filtered down quickly to the local level, where county health officials and pharmacies have been left to interpret the vague federal language.
“We've seen that (the CDC) have not used an evidence-based model. They have not used a transparent model, and so what that means is there's now no confidence in their recommendations.”
To clear up some of the confusion, Colorado Gov. Jared Polis issued a standing order in September allowing pharmacies to administer Covid-19 vaccines to individuals without prescription. The order streamlined access to the vaccine for Coloradans, but access to immunizations still somewhat depends on insurance and age demographic.
According to Batty, all health insurance companies are generally required to follow CDC guidelines. However, the “shared clinical decision making” parameter somewhat limits vaccine access to those who receive immunization directly from their medical provider.
“What that boils down to is insurance companies under the Affordable Care Act are required to cover CDC routinely recommended vaccines and grant programs that help provide vaccines to people who don't have insurance,” Batty said. “They are being covered by insurance companies, but it's a little difficult to get access through some channels like pharmacies. That shared clinical decision making piece means it's for people who access their vaccines through their physician.”
Guidelines for those who are under 64 and do not have a regular physician are less clear. Although pharmacies are subject to the CDC recommendation that requires shared clinical decision making, Colorado law allows them to take some liberties.
“Walgreens, CVS and King Soopers are requiring people who aren't 65 or older to attest to a question that says, ‘Do you have a condition that qualifies you for covid?,’” Batty said. “Anecdotally, we've heard a lot of them aren't following up. They're just allowing people to kind of self attest.”
The burden in this case then falls to the requirements set forth by insurance, which may adhere to the more strict interpretation of federal policies for coverage. Some individuals may need to spend significant time waiting for their claim to be approved, and if denied, the out-of-pocket cost for a Covid-19 shot is typically more than $200.
Federal restrictions also apply most directly to residents who rely on government-subsidized health insurance and vaccine grant programs. As a result, people who use walk-in clinics or public programs are encountering delays tied to federal supply caps and unclear eligibility rules.
“So we're already seeing that people who are marginalized and aren't able to access health care through traditional channels are now not able to access this vaccine at the same time as other people because of these delays at the federal level,” Batty said.
Those delays are being worsened by dose restrictions placed on the two federal programs that supply vaccines for underinsured and uninsured Coloradans. Larimer County is now limited in how much it can order from the Vaccines for Children program and the Section 317 program for adults.
“Currently, we have been limited on how much we can order through both the VFC program for children and the 317 program for adults,” Batty said.
Pediatric clinics have also been strained by the discontinuation of the MMRV combination vaccine for children ages 1 through 4, leaving fewer options for families and creating additional appointment bottlenecks.
Batty warned that if vaccination rates continue to fall due to reduced access and rising misinformation, preventable deaths will increase.
“If people are not being vaccinated, there are hundreds of deaths every year that we could have prevented,” Batty said.
Still, he emphasized that local health officials are focused on providing accurate information rather than pressuring residents.
“This isn't about trying to force people to do anything,” he said. “It's about cutting through misinformation so people can make informed decisions to protect themselves, their families and our community at large.”
Chloe Waskey is a CSU student majoring in Journalism and Media Communication with a minor in political science.